MEDICARE: MR. RODOLFO FELIPE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4508	TN

General Provider Information

NPI Number	:	1306814611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODOLFO FELIPE P.T.

Provider Business Mailing Address
First Line	:	8885 DEXTER RD
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-1019
Country	:	US
Telephone Number	:	901-751-2433
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 POPLAR AVE
Second Line	:	SUITE 1000
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4701
Country	:	US
Telephone Number	:	901-761-7112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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